清开灵注射液对LPS诱导的兔弥散性血管内凝血的作用

目的: 研究清开灵注射液对脂多糖(LPS)诱导的兔弥散性血管内凝血(DIC)的作用。方法: 采用耳缘静脉持续滴注LPS的方法建立兔弥散性血管内凝血模型,观察各组动物24 h内各时点生存率;采用全自动凝血分析仪检测活化部分凝血活酶时间(APTT)和凝血酶原时间(PT);凝固法测定纤维蛋白原含量;全自动血细胞分析仪进行血小板计数;全自动血浆分析仪测定丙氨酸氨基转移酶(ALT)以及血尿素氮(BUN);发色底物法测定蛋白C及抗凝血酶Ⅲ的活性;ELISA法检测血浆肿瘤坏死因子α(TNF-α)含量。结果: 兔静脉持续滴注LPS后,APTT和PT显著延长,ALT和BUN显著升高,蛋白C和抗凝血酶Ⅲ的活性明显降低,血小板计数显著减少,血浆TNF-α含量显著升高。给予清开灵注射液后,APTT和PT的延长明显缩短,血小板计数、纤维蛋白原含量、蛋白C及抗凝血酶Ⅲ活性均明显恢复;ALT、BUN以及血浆TNF-α含量明显降低。结论: 清开灵注射液对LPS所诱导的兔弥散性血管内凝血有良好的拮抗作用。     

血栓通注射液对LPS诱导的兔弥散性血管内凝血的拮抗作用

 目的：研究血栓通注射液对脂多糖（LPS）诱导的兔弥散性血管内凝血（DIC）的影响。方法：对兔耳缘静脉持续滴注LPS以建立兔DIC模型,记录各组动物在24 h后的生存率;全自动血浆分析仪测定丙氨酸氨基转移酶(ALT)和血尿素氮(BUN);用全自动凝血分析仪检测活化部分凝血活酶时间（APTT）和凝血酶原时间（PT）;用凝固法测定纤维蛋白原含量;全自动血细胞分析仪进行血小板计数;发色底物法测定蛋白C和抗凝血酶Ⅲ的活性;ELISA法检测血浆中肿瘤坏死因子α（TNF-α）的含量。结果：持续从兔耳缘静脉滴注LPS后,DIC模型组动物大量死亡,ALT和BUN显著升高,APTT和PT显著延长,蛋白C和抗凝血酶Ⅲ的活性明显降低,血小板计数明显减少,血浆中TNF-α的含量显著升高。注射血栓通注射液后,动物的死亡率明显下降,ALT和BUN明显下降,APTT和PT明显缩短,血小板计数明显上升,纤维蛋白原含量显著提高,蛋白C和抗凝血酶Ⅲ活性明显提升;血浆TNF-α的含量明显降低。结论：血栓通注射液对LPS所诱导的兔DIC有良好的拮抗作用。     

复方丹参注射液抗脂多糖诱导的兔弥漫性血管内凝血

目的: 研究复方丹参注射液对脂多糖(LPS)诱导的兔弥漫性血管内凝血(DIC)的作用。方法: 用LPS诱导兔DIC模型。凝固法测定纤维蛋白原含量,全自动凝血分析仪检测活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)和纤维蛋白原含量;全自动血细胞分析仪进行血小板计数;全自动血浆分析仪测定谷丙转氨酶(ALT)以及血尿素氮(BUN);发色底物法测定蛋白C及抗凝血酶Ⅲ的活性。观察复方丹参注射液对LPS诱导的兔DIC的拮抗作用。结果: 兔耳缘静脉持续滴注LPS,观察到:APTT和PT显著延长;血小板计数和纤维蛋白原含量明显减少;ALT和BUN显著升高;蛋白C和抗凝血酶Ⅲ的活性明显降低。给予复方丹参注射液后,APTT和PT的延长明显缩短;血小板计数和纤维蛋白原的含量均明显恢复;ALT和BUN显著下降;蛋白C及抗凝血酶Ⅲ的活性显著改善。结论: 复方丹参注射液对LPS诱导的兔DIC有良好的拮抗作用。     

弥散性血管内凝血诊断和治疗的若干进展

弥散性血管内凝血(DIC)是在多种疾病基础上发生的临床综合征。DIC主要特征是人体的内环境失平衡,以致凝血与抗凝血平衡失调,在毛细血管内纤维蛋白沉积和血小板聚集,导致继发性凝血因子和血小板消耗性减少,微循环障碍及组织缺血。临床表现为出血倾向、微循环衰竭或休克、微血栓形     

产科弥散性血管内凝血的处理体会

目的 探讨产科DIC的临床特点及诊治策略.方法 对我院收治的13例产科DIC患者临床资料进行回顾性分析.结果 ①产科DIC的发生与严重产科并发症,如重度子痫前期、前置胎盘、胎盘早剥、宫内死胎、产后出血、羊水栓塞、重症肝炎等相关;②13例中3例行子宫切除,其中2例系胎盘早剥、子宫卒中, 1例为中央型前置胎盘,部分胎盘植入, 13例抢救成功,无1例患者死亡.结论 早预防,早诊断,早治疗,积极防治多器官功能衰竭(MODS),是抢救产科DIC的有效方法.     

微剂量肝素预防治疗急性髓系白血病弥散性血管内凝血

目的 :探讨急性髓系白血病 (AML)合并弥散性血管内凝血 (DIC)肝素治疗的最有效剂量。方法 :中小剂量肝素(Midlowdoseheparin ,MLDH)肝素用量为 12 5～ 2 5 0U/kg ,2次 /日治疗 (19例 )及微剂量肝素 (亦称超小剂量肝素 ,Ul tralowdoseheparin ,ULDH)肝素用量为 2 5～31.2 5U/kg ,2次 /日治疗 (19例 )AML合并DIC38例 ,给药途径均为腹部脐周或上臂内侧皮下注射。按全国统一标准评定疗效。结果 :MLDH肝素治疗后部分病人有新的出血 ,早期死亡率高 ,化疗过程中DIC的治愈率为 (4/ 18) 2 2 % ,明显低于ULDH治疗组 (12 / 2 0 )的 6 0 % ,且必须进行DIC监测。结论 :ULDH临床无出血倾向 ,不须进行实验室监测 ,早期死亡率明显降低 ,可以作为预防治疗AML并DIC的首选药物剂量。     

产科急性弥散性血管内凝血的临床分析

目的探讨产科急性弥散性血管内凝血（DIC）的临床特点和治疗方法。方法对2003年1月～2008年12月本院收治的24例产科急性弥漫性血管内凝血（DIC）患者的临床资料进行回顾性分析,并查阅相关文献。结果①产科急性弥散性血管内凝血的发生的诱发因素：胎盘早剥（4例）,羊水栓塞（3例）,产后出血（5例）,HELLP综合征（3例）,流产（2例）,子痫和先兆子痫（5例）,前置胎盘（2例）;②24例患者中剖宫产16例,子宫切除5例,剖宫产后子宫切除3例;③抢救成功20例,成功率83.3%。结论早预防,早诊断,早治疗,积极防治多器官功能衰竭（MODS）,是抢救产科急性弥散性血管内凝血的有效方法。同时纠正凝血功能。     

产科弥散性血管内凝血32例临床分析

目的探讨产科弥散性血管内凝血早期诊断,正确治疗及提高抢救成功率的方法。方法对32例产科弥散性血管内凝血病例的临床资料诊治回顾性分析。结果产科弥散性血管内凝血发病诱因依次为:妊高征,胎盘早剥,羊水栓塞,产后大出血,宫内死胎,妊娠合并肝病等。结论早期明确弥散性血管内凝血的诊断,同时大量输新鲜血、血小板及新鲜血浆,及时使用肝素,果断决定切除子宫是抢救产科弥散性血管内凝血病例的有效方法。     

慢性肺心病急性加重期并弥散性血管内凝血29例分析

目的探讨慢性肺心病急性加重期合并弥漫性血管内凝血(DIC)的临床特点。方法对1995-2004年收治的29例慢性肺心病并DIC的临床资料进行回顾性分析。结果慢性肺心病急性加重期并DIC,出血29例,上消化道出血18例,休克15例,11例痊愈,18例死亡,病死率62.1%。结论慢性肺心病急性加重期并DIC病死率高,早期预防,早期诊断是降低病死率的关键。     

弥散性血管内凝血的放射自显影研究

大白鼠注射~(125)I标记的纤维蛋白原后,再注射凝血酶,造成弥散性血管内凝血。放射自显影检查发现,同位素标记的微血栓主要位于肾小球毛细血管,直小血管之中。肺泡的毛细血管也可发现这些微血栓。肝脏和脾脏的网状内皮细胞吞噬了大量的标记物质,这些吞噬细胞定位在肝门区,而在脾脏则位于马氏小体周围。此外,在肾小管的上皮细胞内也发现有同位素,这些物质可能是通过肾小球过滤而被肾小管重吸收的标记物质。用自显影术,常规染色和纤维蛋白的特殊染色互相比较,肺的微血栓在常规和特殊染色中不能被发现,用自显影术则很易检出同位素标记的微血栓。     

Plasma factor XIII activity in patients with disseminated intravascular coagulation

The objective of this study was to investigate the correlation between factor XIII (FXIII) activity and disseminated intravascular coagulation (DIC) parameters and also to evaluate the clinical usefulness of DIC diagnosis. Citrated plasma from eighty patients with potential DIC was analyzed for FXIII activity. The primary patient conditions (48 male and 32 female, mean age, 51 years) were malignancy (n = 29), infection (n = 25), inflammation (n = 6), heart disease (n= 3), thrombosis (n = 2), injury (n = 2), and other miscellaneous conditions (n = 13). FXIII testing was performed using the CoaLinkTM FXIII Incorporation Assay Kit (PeopleBio Inc.). Among 80 patients who were suspected to have DIC based on clinical analysis, 46 (57.5%) fulfilled the overt DIC criteria (DIC score > = 5) according to the International Society of Thrombosis and Haemostasis. FXIII levels in the plasma were significantly decreased in overt DIC compared to non-overt DIC patients (mean 75.1% and 199.7% respectively, p < 0.0001). Interestingly, we found a significant inverse correlation between DIC scores and FXIII activity. In addition, FXIII activity significantly correlated with other hemostatic markers that included platelet count, prothrombin time, activated partial thromboplastin time, fibrinogen, and D-dimer. FXIII levels were significantly lower in patients with liver or renal dysfunction. In conclusion, FXIII cross-linking activity measurements may have differential diagnostic value as well as predictive value in patients who are suspected to have DIC.     

Pancreatic ischaemic lesions without fat necrosis associated with disseminated intravascular coagulation

We examined the primary ischaemic changes in the pancreas in 35 patients with disseminated intravascular coagulation. In 7 (20%), multiple patchy lesions composed of degenerative acinar cells indicating coagulation necrosis were noted. None of these lesions was accompanied by fat necrosis. The patchy lesions involved the islets of Langerhans in only 1 case. The interlobular arteries of the pancreas near these lesions contained fibrin thrombi in all 7 cases. We suggest that these lesions, without fat necrosis, are the distinctive ischaemic change associated with disseminated intravascular coagulation.     

Immunohistochemical study on the liver in autopsy cases with disseminated intravascular coagulation (DIC) with reference to clinicopathological analysis

Summary Immunohistochemical and clinicopathological studies were performed in 27 autopsy cases with indisputable DIC, which had been selected from 1,800 autopsy cases of elderly people based on the following two criteria; 1. presence of fibrin thrombi in glomeruli, and 2. presence of fresh patchy necrotic foci in myocardium and/or fibrin thrombi in splenic sinuses. A high incidence of liver lesions (22/27) was revealed in autopsy cases with indisputable DIC. The liver lesions could be classified into four groups. Group-I (Central degeneration) was characterized by massive precipitation of fibrin irregularly around the central vein, causing parenchymal damage. Group-II (Central necrosis), showed coagulation necrosis in the cental zone due to circulatory disturbance caused by either shock as a cause of DIC or abrupt cessation of blood flow into the lobules following fibrin thrombus formation in vessels of Glisson's sheath. Both group-I and -II showed a short clinical duration of DIC. Group-III (Sinusoidal thrombosis), showed the presence of fibrin thrombi in sinusoids with mild parenchymal damage and long clinical duration of DIC. Group-IV (No thrombosis), showed neither parenchymal damage nor fibrin thrombi in sinusoids, but a long clinical duration of DIC.     

家兔内毒素性DIC病理过程中的自由基反应与红细胞膜损伤

本实验用内毒素诱导家兔Shwartzman反应为DIC模型,以分子生物力学、生物化学检测方法,对该病理过程中自由基反应与红细胞膜损伤关系进行了研究,以进一步探讨自由基反应在内毒素DIC病理机制中的作用。结果表明:模型组红细胞膜LPO含量(0.285±0.063)、膜脂质微粘度(η,3.008±0.112)与对照组(0.214±0.055;η,2.688±0.117)比较明显增高(P<0.05;P<0.001),而红细胞SOD活力(1632.16±354.98)与对照组(2194.32±410.31)比较明显降低(P<0.02)。相关分析表明:红细胞LPO含量与红细胞SOD活力呈明显负相关(r=-0.686;P<0.05),与红细胞膜脂微粘度呈明显正相关(r=0.552,P<0.05)。提示内毒素性DIC时,红细胞膜损伤的主要因素除内毒素直接作用外,与自由基在膜上发生的过氧化反应有关,并可能是促进DIC发生发展的重要因素之一。     

Etiopathology and classification of acquired coagulation disorders in the newborn infant

Summary In the newborn period low vitamin K dependent coagulation factors are frequently found in connection with normal global tests. To investigate this peculiar coagulation status studies were performed in 54 newborns who were divided into three groups according to their clinical course and the existence of bleeding. The results are compared to coagulation tests used for the diagnosis of disseminated intravascular coagulation (DIC).An early sign of an increased turnover of coagulation factors is a difference in the fibrinogen concentration determined by an immunological technique and a coagulation test which is sensible to fibrin(ogen)-degradation-products (FDP's). At this stage factor II, V and VII levels are still within the normal range suggesting an increased production. In a more severe disturbance of the clotting system the increased turnover is no longer compensated by an increased production, and platelets and later on factor II and VII levels are lowered. At this early stage of DIC the vitamin K dependent factors are correlated to the factors I and V. Finally factors I and V drop as well. This stage in most infants is accompanied by the clinical symptom of bleeding.The clotting tests results are well correlated to the severity of the disease.With support of the Ministerium für Wissenschaft und Forschung des Landes Nordrhein-Westfalen